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What is Alcoholic Cirrhosis?

Alcoholic cirrhosis is an alcohol-induced liver disease that has advanced to the late stage. Alcoholic liver disease (ALD) is a term used to describe a range of liver conditions that include fatty liver, alcoholic hepatitis or severe alcoholic hepatitis, alcoholic liver cirrhosis, and hepatocellular carcinoma.2

Alcoholic cirrhosis is cirrhosis of the liver caused by alcohol use. It is an end-stage liver disease that occurs after years of alcohol intake. 

The liver is the largest internal organ. It plays vital roles in the body, such as breaking down proteins, filtering blood, and producing bile that aids fat absorption. Excess alcohol intake over time can cause liver diseases and scar tissue (liver fibrosis) which can interfere with liver function.

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), alcohol-related liver disease is the major cause of deaths related to alcohol intake. Heavy alcoholics typically progress from fatty liver to hepatitis and cirrhosis.6

Decades of heavy alcohol intake will cause the body to replace healthy liver tissue with scar tissue. The medical term for this is “alcoholic liver cirrhosis.” As alcoholic liver disease progresses, more healthy liver tissue is replaced by scar tissue. Liver diseases like alcoholic liver cirrhosis impair liver function.

What Causes Alcohol-Induced Cirrhosis?

Alcoholic liver cirrhosis is an advanced form of alcohol-related liver disease caused by years of alcohol abuse.1

According to an article published in the Clinical Liver Disease journal, heavy alcohol consumption of about 60 to 80g/day for men or 20 to 50g/day for women increases the risk of alcoholic liver cirrhosis.7

Different things can cause cirrhosis of the liver. However, alcohol-induced cirrhosis is directly linked to chronic alcohol use. Typically, a person has to drink heavily for at least eight years to develop this condition. The NIAAA defines heavy drinking as consuming more than 14 drinks per week for men and more than seven drinks per week for women.3

When a person drinks alcohol excessively, it can lead to fatty liver. Fatty liver is the accumulation of fats in the liver, which causes liver enlargement. 

From fatty liver, the condition progresses to severe acute alcoholic hepatitis. Alcoholic hepatitis occurs when healthy liver cells die. This is closely followed by hepatic fibrosis and the formation of hepatic scar tissue in place of the healthy liver tissue.

Since the liver is actively involved in the breakdown of alcohol, it makes sense that excess alcohol consumption can damage and impair liver function. 

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Who is More at Risk of Developing Alcoholic Cirrhosis?

Alcohol reduces life expectancy, and people who drink alcohol heavily are prone to developing cirrhosis. 

The most significant risk factor for alcoholic liver cirrhosis is chronic alcohol abuse. 

In 2010, alcoholic cirrhosis, which is an alcohol-related liver disease, caused the death of 493,300 people (336,400 male deaths and 156,900 female deaths) globally.8

Other risk factors of alcoholic cirrhosis are:

  • Gender: Women have a higher risk of developing alcohol-related diseases. This is because they do not have as many enzymes in their stomachs as their male counterparts to break down alcohol. This makes it easier for alcohol to reach the liver and cause damage to the healthy liver cells.
  • Genetic factors: The development of alcoholic liver disease can also be linked to genetic factors. For instance, people born with a deficiency of enzymes involved in alcohol elimination have a higher risk of developing alcohol-induced liver disease.
  • Disease conditions: Some diseases such as hepatitis C and obesity can increase a person’s likelihood of developing alcoholic liver disease.

What are the Symptoms of Alcoholic Liver Cirrhosis?

Alcoholic liver cirrhosis is a chronic liver disease, and people with the condition are usually asymptomatic during the early stages. However, advanced alcoholic cirrhosis presents with noticeable symptoms.

Alcoholic liver cirrhosis has similar symptoms as other diseases affecting the liver. Symptoms of alcohol-induced cirrhosis of the liver include:

  • Jaundice (yellow discoloration of the eyes and skin)
  • Fatigue
  • Nausea
  • Skin itching
  • Weight loss
  • Portal hypertension (high blood pressure in veins that supply the liver)
  • Bruising or bleeding easily
  • Loss of sex drive
  • Redness in palms of the hand
  • Ascites (accumulation of fluid in the abdomen)
  • Confusion and drowsiness
  • Slurred speech
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Alcoholic Liver Cirrhosis vs. Non-Alcoholic Liver Cirrhosis 

Alcoholic liver cirrhosis and non-alcoholic liver cirrhosis both present with cirrhosis of the liver. However, the difference in both conditions lies in their causes.

Alcoholic liver cirrhosis is caused by chronic, excessive intake of alcohol over a period of time. On the other hand, other factors not related to alcoholism can predispose someone to non-alcoholic liver cirrhosis. Cirrhosis of the liver that is not caused by drinking is called non-alcoholic liver cirrhosis.

Factors that can predispose someone to non-alcoholic liver cirrhosis include:

  • Being overweight or obese
  • Hyperglycemia (high level of sugar in the blood)
  • Insulin resistance
  • High fat levels (particularly triglycerides) in the blood

Too much accumulation of fats in the liver can cause a condition known as non-alcoholic fatty liver disease (NAFLD). The main complication of NAFLD is advanced-stage scarring of the liver.

Potential Complications of Alcoholic Cirrhosis

Alcoholic cirrhosis can result in serious complications such as liver cancer. This is called decompensated cirrhosis. Decompensated alcoholic cirrhosis is when liver function has been impaired as a result of alcohol abuse. 

Some potential complications of alcoholic liver cirrhosis are:

  • Internal bleeding
  • Jaundice
  • Ascites
  • Swelling in the legs
  • Liver cancer
  • Hepatic encephalopathy (a nervous system disorder caused by severe liver disease)
  • Splenomegaly (enlargement of the spleen)
  • Malnutrition
  • Infections

How Long Can You Live With Alcoholic Cirrhosis?

The lifespan of people living with liver cirrhosis depends on the stage of cirrhosis. While people whose bodies can compensate for and manage the condition can live for 6 to 12 years, people with an advanced stage liver disease can only survive for a shorter duration.

About 50 percent of people living with severe alcoholic cirrhosis live for up to 2 years, and only about 35 percent live for up to 5 years.4

Diagnosis & Treatment of Alcoholic Liver Cirrhosis

Alcoholic liver cirrhosis is typically diagnosed when a history of habitual heavy alcohol consumption over a long duration is established coupled with laboratory evidence of liver cirrhosis. 

Alcohol dependence alone is not sufficient in determining if an individual has cirrhosis of the liver. However, it is a significant factor during diagnosis. Alcoholic liver diseases like cirrhosis may be difficult to diagnose as some patients deny alcohol abuse.

The first step in treating alcoholic liver cirrhosis is to quit alcoholism. This is called abstinence. Quitting alcoholism can help reverse the early stages of liver disease. Treatment for alcoholism includes:

  • Abstinence
  • Detox
  • Medication-assisted therapy (MAT)
  • Therapy (cognitive behavioral therapy, family therapy, and psychotherapy)
  • Support groups

It is also important for people with liver cirrhosis to make certain lifestyle changes. For instance, quitting smoking, taking multivitamins, and weight loss may be recommended.

Other treatment options for alcoholic liver cirrhosis is the use of medications, liver transplant, and stem cell therapy. 

Is Cirrhosis Reversible?

Many clinicians believe liver damage from cirrhosis is irreversible. However, some studies have shown evidence that liver cirrhosis may be reversible.5 Also, recovery from this condition will depend on the type of cirrhosis an individual has and if they stop drinking.

Scientists are still making efforts to develop better medical treatment options for alcoholic liver disease. Early diagnosis and treatment can help prevent further damage.

Liver cirrhosis is an advanced liver disease, and as cirrhosis progresses, they cause more damage. Quitting drinking immediately can help increase life expectancy.

Resources

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Alcoholic Cirrhosis.” Stanford Health Care.

Basra, Sapreet, and Anand Bhupinderjit. “ Definition, Epidemiology, and Magnitude of Alcoholic Hepatitis.” World Journal of Hepatology, vol. 3,5 (2011): 108-113.

Drinking Levels Defined.” National Institute on Alcohol Abuse and Alcoholism.

Gunter, Jeffrey. “ Cirrhosis: Advanced Liver Disease.” NATAP.

Jung, Kul, and Yim Hyung. “ Reversal of Liver Cirrhosis: Current Evidence and Expectations.” The Korean Journal of Internal Medicine, vol. 32,2, (2017): 213-228. Doi: 10.3904/kjim.2016.268.Mann, Robert et al. “The Epidemiology of Alcoholic Liver Disease.” Alcohol Research & Health, vol. 27,3, (2003): 209-219.

Mellinger, Jessica. “ Epidemiology of Alcohol Use and Alcoholic Liver Disease.” Clinical Liver Disease, vol. 13,5, (2019): 136-139.

Rhem, Jurgen, et al. “Global Burden of Alcoholic Liver Diseases.” Journal of Hepatology, vol. 59,1, (2013): 160-168.

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